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Bjarnason-Wehrens B, Schmidt T, Schwaab B. [Cardiopulmonary exercise testing for exercise prescription in cardiac rehabilitation]. Herzschrittmacherther Elektrophysiol 2023; 34:26-32. [PMID: 36720723 DOI: 10.1007/s00399-022-00921-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/20/2022] [Indexed: 02/02/2023]
Abstract
Aerobic endurance training is a core component of exercise training (ET) during cardiac rehabilitation (CR). Improvements of cardiopulmonary performance and symptom-free exercise capacity that can be achieved by ET during CR are essential for patient's prognosis and quality of life. Before initiating exercise training in CR, a detailed risk stratification including incremental exercise testing is required in order to ensure safe and effective exercise training conditions. Cardiopulmonary exercise testing (CPX) with measurement of respiratory gases is considered the gold standard of cardiopulmonary performance diagnostics. The oxygen uptake measured at the highest exercise intensity achieved (peakVO2) has strong prognostic implications in primary and secondary prevention of cardiovascular diseases, respectively. The use of CPX with measurement of peakVO2 and determination of ventilatory thresholds (VT) enables a reliable determination of the individual cardiopulmonary performance (peakVO2) and also the aerobic exercise capacity. In addition, CPX is a valuable tool to detect increments in exercise capacity that were achieved by ET during CR. The measurement of peakVO2 and the determination of ventilatory thresholds are basic parameters for an individually tailored exercise prescription. In addition, the targeted control of aerobic endurance training on the basis of CPX parameters increases the effectiveness and safety of the exercise program during CR. In this article, recommendations for an individual exercise prescription, based on the results of CPX, are given for patients with coronary heart disease (CHD), heart failure, as well as for patients with CHD and concomitant type 2 diabetes mellitus.
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Affiliation(s)
- Birna Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland.
| | - Thomas Schmidt
- Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland.,Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Deutschland
| | - Bernhard Schwaab
- Rehabilitationskrankenhaus für Kardiologie, Angiologie und Diabetes, Curschmann Klinik, Timmendorfer Strand, Deutschland.,Medizinische Fakultät, Universität zu Lübeck, Lübeck, Deutschland
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Moxley E, Habtezgi D, Subramanian V, Hwang S, Yalla S, Attewell L. Relationships Between Physical Activity Metrics of Intensity and Diabetes. J Cardiovasc Nurs 2022; 38:00005082-990000000-00035. [PMID: 36037295 DOI: 10.1097/jcn.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Physical activity (PA) prevents diabetes-associated complications. Little is known about what constitutes effective PA interventions to mitigate diabetes. Identifying PA metrics associated with the efficacy of PA interventions will provide insight into devising strategies to treat diabetes. PURPOSE The aim of this study was to analyze the relationships between preclinical and postclinical variables from a 10-week intervention designed to increase PA in adults with diabetes. METHODS A secondary analysis was performed to evaluate data using Wilcoxon rank sum test, permutation test and Spearman correlation to analyze hemoglobin A1c (HbA1c), weight, and PA metrics (maximum steps per episode, cadence, daily steps, and 6-minute walk). RESULTS Poststudy HbA1c level was associated with maximum steps (r = -0.63, P = .03) and 6-minute walk (r = -0.50, P = .09). Baseline weight was associated with average cadence (r = -0.76, P = .007), and poststudy weight was associated with average cadence (r = -0.60, P = .041) and maximum steps (r = -0.62, P = .03). CONCLUSIONS Cadence and maximum steps per episode reflect PA intensity and were associated with HbA1c and weight in adults with diabetes.
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Heo JW, No MH, Cho J, Choi Y, Cho EJ, Park DH, Kim TW, Kim CJ, Seo DY, Han J, Jang YC, Jung SJ, Kang JH, Kwak HB. Moderate aerobic exercise training ameliorates impairment of mitochondrial function and dynamics in skeletal muscle of high-fat diet-induced obese mice. FASEB J 2021; 35:e21340. [PMID: 33455027 DOI: 10.1096/fj.202002394r] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 12/31/2022]
Abstract
The purpose of this study is to determine whether moderate aerobic exercise training improves high-fat diet-induced alterations in mitochondrial function and structure in the skeletal muscle. Male 4-week-old C57BL/6 mice were randomly divided into four groups: control (CON), control plus exercise (CON + EX), high-fat diet (HFD), and high-fat diet plus exercise (HFD + EX). After obesity was induced by 20 weeks of 60% HFD, treadmill exercise training was performed at 13-16 m/min, 40-50 min/day, and 6 days/week for 12 weeks. Mitochondrial structure, function, and dynamics, and mitophagy were analyzed in the skeletal muscle fibers from the red gastrocnemius. Exercise training increased mitochondrial number and area and reduced high-fat diet-induced obesity and hyperglycemia. In addition, exercise training attenuated mitochondrial dysfunction in the permeabilized myofibers, indicating that HFD-induced decrease of mitochondrial O2 respiration and Ca2+ retention capacity and increase of mitochondrial H2 O2 emission were attenuated in the HFD + EX group compared to the HFD group. Exercise also ameliorated HFD-induced imbalance of mitochondrial fusion and fission, demonstrating that HFD-induced decrease in fusion protein levels was elevated, and increase in fission protein levels was reduced in the HFD + EX groups compared with the HFD group. Moreover, dysregulation of mitophagy induced by HFD was mitigated in the HFD + EX group, indicating a decrease in PINK1 protein level. Our findings demonstrated that moderate aerobic exercise training mitigated obesity-induced insulin resistance by improving mitochondrial function, and reversed obesity-induced mitochondrial structural damage by improving mitochondrial dynamics and mitophagy, suggesting that moderate aerobic exercise training may play a therapeutic role in protecting the skeletal muscle against mitochondrial impairments and insulin resistance induced by obesity.
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Affiliation(s)
- Jun-Won Heo
- Department of Biomedical Science, Program in Biomedical Science & Engineering, Inha University, Incheon, Republic of Korea.,Institute of Sports & Arts Convergence, Inha University, Incheon, Republic of Korea
| | - Mi-Hyun No
- Department of Kinesiology, Inha University, Incheon, Republic of Korea
| | - Jinkyung Cho
- Institute of Sports & Arts Convergence, Inha University, Incheon, Republic of Korea
| | - Youngju Choi
- Institute of Sports & Arts Convergence, Inha University, Incheon, Republic of Korea
| | - Eun-Jeong Cho
- Department of Biomedical Science, Program in Biomedical Science & Engineering, Inha University, Incheon, Republic of Korea.,Institute of Sports & Arts Convergence, Inha University, Incheon, Republic of Korea
| | - Dong-Ho Park
- Department of Biomedical Science, Program in Biomedical Science & Engineering, Inha University, Incheon, Republic of Korea.,Institute of Sports & Arts Convergence, Inha University, Incheon, Republic of Korea.,Department of Kinesiology, Inha University, Incheon, Republic of Korea
| | - Tae-Woon Kim
- Department of Physiology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chang-Ju Kim
- Department of Physiology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Dae Yun Seo
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Republic of Korea
| | - Jin Han
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Republic of Korea
| | - Young C Jang
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Su-Jeen Jung
- Department of Leisure Sports, Seoil University, Seoul, Republic of Korea
| | - Ju-Hee Kang
- Department of Biomedical Science, Program in Biomedical Science & Engineering, Inha University, Incheon, Republic of Korea.,Institute of Sports & Arts Convergence, Inha University, Incheon, Republic of Korea.,Department of Pharmacology, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hyo-Bum Kwak
- Department of Biomedical Science, Program in Biomedical Science & Engineering, Inha University, Incheon, Republic of Korea.,Institute of Sports & Arts Convergence, Inha University, Incheon, Republic of Korea.,Department of Kinesiology, Inha University, Incheon, Republic of Korea
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Schwaab B, Windmöller M, König IR, Schütt M. Evaluation of Aerobic Exercise Intensity in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus. J Clin Med 2020; 9:jcm9092773. [PMID: 32867079 PMCID: PMC7565303 DOI: 10.3390/jcm9092773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Physical activity is recommended in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) to reduce hyperglycemia and cardiovascular risk. Effective aerobic exercise intensity, however, is not well defined. (2) Methods: 60 consecutive patients performed cardiopulmonary exercise testing (CPX) of 30 min duration targeting a respiratory exchange ratio (RER) between 0.85 and 0.95, being strictly aerobic. Plasma glucose (PG) was measured before and after CPX as well as one and two h after exercise. Maximum exercise intensity was evaluated using a standard bicycle exercise test. (3) Results: 50 patients completed the protocol (62 ± 10 years, BMI (body mass index) 30.5 ± 4.9 kg/m2, HbA1c (glycated haemoglobin) 6.9 ± 0.8%, left ventricular ejection fraction 55 ± 8%). Aerobic exercise capacity averaged at 32 ± 21 Watt (range 4–76 Watt) representing 29.8% of the maximum exercise intensity reached. PG before and after CPX was 9.3 ± 2.2 and 7.6 ± 1.7 mmol/L, respectively (p < 0.0001). PG was further decreased significantly at one and two h after exercise to 7.5 ± 1.6 mmol/L and 6.0 ± 1.0 mmol/L, respectively (p < 0.0001 for both as compared to PG before CPX). (4) Conclusions: Aerobic exercise capacity is very low in patients with CAD and T2DM. Exercise at aerobic intensity allowed for significant reduction of plasma glucose. Individual and effective aerobic exercise prescription is possible by CPX.
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Affiliation(s)
- Bernhard Schwaab
- Curschmann Klinik, Rehabilitation Clinic for Cardiology, Angiology and Diabetes, 23669 Timmendorfer Strand, Germany;
- Correspondence: ; Tel.: +49-4503-602-154; Fax: +49-4503-602-660
| | - Mirca Windmöller
- Curschmann Klinik, Rehabilitation Clinic for Cardiology, Angiology and Diabetes, 23669 Timmendorfer Strand, Germany;
| | - Inke R. König
- Institute of Medical Biometry and Statistics, University Hospital Schleswig Holstein, Campus Lübeck, University of Lübeck, 23562 Lübeck, Germany;
| | - Morten Schütt
- Institute for Diabetes and Endocrinology, 23552 Lübeck, Germany;
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